Assignment of Liability Form
Leasing of Osage Reservation Lands for Oil and Gas Mining (25 CFR 226)
Osage_Assignment Liability Form
Lessee submits assignment or transfer of lease
OMB: 1076-0180
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1076-0180 can be found here:
Document [rtf]
Download: rtf | pdf
OMB# 1076-0180
Expires XX-XXXX
OMB# 1076-0180
Expires XX-XXXX
-
Assignment Liability Form
Lessee Contact Information:
Assignee: |
Phone Number: |
|
Address: |
|
|
City: |
State: |
Zip: |
Non-Compliance
Issue(s):
The
following work shall be
completed
by
:
See letter for other
pertinent information regarding instructions, extensions &
regulations.
I/We assume the responsibility of the above corrective actions related to the above described lease.
Name
(Printed)
Signature
Date
| File Type | text/rtf |
| Author | Swift, Michael Paul |
| Last Modified By | SYSTEM |
| File Modified | 2018-07-30 |
| File Created | 2018-07-30 |
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